Music for untying restrained patients.

The purpose of this descriptive pilot study was two-fold: (a) to test psychometrically an observational instrument designed to measure patient behaviors displayed while unrestrained and receiving a musical intervention; and (b) to determine the effect of a musical intervention on the behavioral reactions of physically restrained patients. The Restraint-Music Response Instrument (RMRI) is a 40-item observational checklist consisting of 22 positive and 18 negative responses developed by the researchers. Content validity was assessed by a panel of experts. The RMRI was tested for interrater reliability using three simulated and 10 actual patients. Results suggest that the RMRI is a valid and reliable measure of patients' responses to music but requires additional study with a control group not receiving the intervention.

Music intervention with physically restrained patients.

Lack of appropriate alternatives to the use of restraints in hospitals and rehabilitation settings is a major concern of nurses. The purpose of this pilot study was to determine the behavioral effects of music intervention with physically restrained patients. The results demonstrated that the number of positive behaviors increased significantly during the music-listening period, during which patients were not restrained, as compared to their typical restrained status. No differences were found that related to the number of negative behaviors displayed before, during, or after the music intervention. Listening to music of their own choosing may help produce positive behaviors in previously restrained patients; however, further studies are needed to confirm this.

Family reactions to restraints in an acute care setting.

1. Families do not realize that a patient has a right to refuse restraints and that the family members have a voice in the decision-making process. 2. Families in general are interested in restraint issues but do not have information at their disposal. 3. Nursing staff should be encouraged to educate family members regarding restraints through open communication and printed material.

Focus groups: nursing staff's experiences using restraints.

A phenomenological approach was used to examine nursing staff's experiences using physical restraints. A total of 12 nurses from a tertiary hospital participated in one of three focus groups. Exploring the attitudes of nurses can contribute to a better understanding of how decisions are made concerning restraints. An analysis of the focus group data resulted in a description of the lived experiences of nurses using restraints. Seven themes emerged from the data, one of which reflected that the nurses felt ambiguous about restraints, yet they made judgments and justified their decisions after assessing patient characteristics, environmental safety, and unit traditions. Nurse clinicians could use the focus group method to sensitize themselves to the staff's needs and to allow staff the opportunity to share ideas and to dispel misconceptions about restraints.

Exploring music intervention with restrained patients.

Roy's Adaptation Model is used in a case study approach to begin examining the potential of music intervention in hospitalized, restrained patients. Restraints were removed during the time in which the patient listened to a musical tape through a headset. Mr. D, presented in this case study, was one of the 30 medical-surgical patients who participated. His observable positive behaviors increased from 10 during the preintervention period to 12 during the musical intervention. Mr. D displayed no negative behaviors during the entire study period.

Physical restraint use in acute care settings.

Increasing reliance on physical restraint devices within hospital settings can be attributed to many reasons, perhaps including litigation. Restraint use represents a quality improvement issue; therefore, a review of all studies involving restraints in acute care settings was conducted. Results of a descriptive study using focus groups is also included. The focus groups explored the decision-making process nurses used in restraining or releasing a patient from a mechanical device.

Physical restraints: has OBRA made a difference?

1. A component of the Omnibus Budget Reconciliation Act of 1987 declared that nursing home residents have the right to be free from physical or chemical restraints that are not required to treat specific "medical symptoms." 2. The literature suggests that the use of restraints has a negative influence on the caregiving process by restricting creativity and individual treatment. 3. Decreased reliance on restraints can be accomplished in nursing homes without an increase in staffing. 4. Transition to limited restraint use requires an organized, planned effort to change attitudes, beliefs, practices, and policies of a facility.

Nursing administrators' perceptions of critical care CNSs.

The literature has demonstrated inconsistencies among nursing administrators in their perceptions of the CNS role functions. Nursing administrators from 198 hospitals were surveyed: (a) to determine the current use of the critical care CNS, (b) to identify the importance placed on the critical care CNS role functions (expert clinician, educator, consultant/change agent, researcher, manager), (c) to ascertain perceptions of specific activities related to each role function, and (d) to determine any differences in perception of role functions between administrators who employed critical care CNSs and those who did not. Nursing administrators who employed critical care CNSs ranked the role of expert clinician as most important, followed by educator, consultant/change agent, and researcher. The role of manager was ranked least important. Nursing administrators who did not employ critical care CNSs ranked the roles in the following order of importance: expert clinician, educator, consultant/change agent, manager, and researcher.